Provider Demographics
NPI:1710620869
Name:MONROE, MALINNA STAR
Entity Type:Individual
Prefix:
First Name:MALINNA
Middle Name:STAR
Last Name:MONROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14489 KEIRNS RD
Mailing Address - Street 2:
Mailing Address - City:MILLFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45761-9797
Mailing Address - Country:US
Mailing Address - Phone:740-508-0947
Mailing Address - Fax:
Practice Address - Street 1:4180 W WILSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9179
Practice Address - Country:US
Practice Address - Phone:740-508-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health